ED Coding and Reimbursement Alert

Question: A patient presents to the emergency department (ED) with two separate raised, irritated lesions on the chest. After examining the lesions and discussing treatment, the physician shaves both during the same session. The first lesion measures 0.8 cm in diameter; the second measures 0.4 cm. The physician documents each lesion’s location, size, and removal technique.

How should I report this encounter?

Revenue Cycle Insider Subscriber

Answer: Since the physician shaved the lesions, you’ll report a separate code for each removal — don’t combine the lengths and choose a code, even though the lesions are in the same anatomical area.

In this case, report the following codes:

• 11301 (Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm) for the removal of the 0.8 cm lesion
• 11300 (… lesion diameter 0.5 cm or less) for the removal of the 0.4 cm lesion

Modifier alert: Depending on payer preference, you’ll want to append modifier 59 (Distinct procedural service) or XS (Separate structure) to 11300 to show that the physician performed two procedures. It might seem counterintuitive to use modifier XS because both lesions were in the same “structure” — the chest. However, according to Medicare payer Noridian, “Modifiers 59 or -XS are used appropriately for different anatomic sites during the same encounter … or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ.”

Michelle Falci, BA, M Falci Communications LLC